Birmingham Council at fault in charging for ‘Interim bed’ when a person was eligible for free Enhanced Assessment Bed (EAB)

Decision Date: 20th January 2020

What Happened

Mr X complained on behalf of his mother, Mrs M.

In January 2019 Mrs M was admitted into hospital, feeling generally unwell. The hospital based social worker told Mr X that on her discharge, she would be placed into an EAB.

  • Enhanced Assessment Beds (EAB) in the area in question were regarded as beds open to all people who have recovered from illness, but cannot be discharged from hospital straightaway and require further social care assessment or period of enablement.
  • An EAB is intended for only a short stay for no more than four weeks. It is free of charge for the time deemed necessary to complete a full assessment for ongoing support. However, if a person’s stay in an EAB bed exceeds the expected discharge date, *expected discharge date from WHERE? charges may apply.

The social worker referred Mrs M for an EAB on the 31st January. Mr X received a letter confirming this, and that it would be free of charge.

On the 4th February, the social worker explained that there were no available EAB beds, so instead offered an ‘interim’ bed.

The social worker told Mr X that this bed would be chargeable and she therefore needed Mr X to complete a financial assessment. Mr X agreed to the referral, and the social worker provided him with a financial assessment form to complete.

Mrs M moved into the interim bed on 13 February 2019.

Mrs M’s financial assessment concluded she would have to contribute £138.10 per week towards the cost of the interim bed.

Following the assessment at the care home, Mrs M moved permanently into another home on 9 April 2019.

What was found

The LGO stated that although Mr X was aware the Council would charge for the interim bed, Mrs M should still not have been charged.

The Council had clearly concluded that she met the criteria for a free EAB bed; it would help to facilitate a quick discharge and carry out an assessment of her needs, which is why the EAB scheme had been created.

The only reason she ended up having to pay a contribution, was because there were no available EAB beds. This is not Mrs M’s fault. It was fault by the Council to charge her for the bed that it subsequently provided to her.

The LGO recommended that the Council pay for Mrs M’s stay in the ‘interim bed’, in line with EAB criteria.

It has also agreed to review if there have been similar cases in the last 12 months that may require a similar remedy.

Points for the public, particularly in the Coronavirus Crisis period – when normal service is suspended, because the NHS is paying for every single package of care required for speedy discharge, but the Council is still doing the contracting…

These ‘beds’ the names of which are bandied around all over the country, do not have any legal underpinning in the statutory framework. A bed is either a placement under s18 of the Care Act, for temporary or permanent care in a care home, or a bed paid for by the NHS for the purposes of Continuing NHS healthcare – or it is a bed which the NHS or council is paying for as part of a strategy for assessment in a stable setting, or for managing shortages of homecare, shortages of CHC assessors, or shortage of vacancies in block contracts for any kind of respite or discharge to assess bed.

Given that commissioned vacancies and booked reablement care often runs OUT in this world, and cannot be enforced, one needs to ask carefully, before discharge, whether what is being offered is:

  • reablement package or bed? (FREE for 6 weeks – usually paid for by the council)
  • An intermediate care package or bed (FREE for 6 weeks – usually paid for by the NHS, when a person needs step-down care with a registered nurse available, before being able to go home, but doesn’t need to be in an acute hospital any longer. Or by the council if it’s a short burst of step UP care, without any registered nurse input other than the district nurse.)
  • rehabilitation service (FREE until a patient has plateau’ed – always funded by the NHS)
  • An interim or ‘discharge to assess bed/package’ – likely paid for by the NHS after a positive CHC checklist or a clear case of complexity of care needs – until one is put through a DST exercise or reviewed with a new checklist and told that one is now needing to engage with the local authority… or by a council if negatively checklisted or not even thought conceivably qualifying, these days – but where the social work input is inadequate to complete an assessment of the full extent of the need or a financial assessment, so the first 4 weeks are free. [this is what we think the Birmingham concept of an EAB was]
  • An empowerment bed – a euphemism favoured in some councils designed to disempower anyone’s knowing what they are actually getting, or why!

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The full Local Government Ombudsman report of Birmingham City Council’s actions can be found here

20https://www.lgo.org.uk/decisions/adult-care-services/charging/19-004-245